Abstract
IntroductionSuccessful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device. We aimed to investigate the intra-aneurysmal and parent vessel hemodynamic changes, as well as the incidence of silent emboli following treatment with various FD devices.MethodsWe evaluated the appearance of the eclipse sign in nine distinct phases of cerebral angiography before and immediately after FD placement in correlation with aneurysm occlusion. Angiographic and clinical data of consecutive procedures were analyzed retrospectively. Patients who had successful FD procedure without adjunctive coiling, visible eclipse sign on post embolization angiography, and reliable follow-up angiographic data were included in the analysis. Detailed analysis of hemodynamic data from transcranial doppler after FD was performed in selected patients, such as monitoring for silent emboli.ResultsAmong all patients (N = 65) who met inclusion criteria, complete aneurysm occlusion at 12 months was achieved in 89% (58/65). Eclipse sign prior to FD was observed in 42% (27/65) with unchanged appearance in 4.6% (3/65) of the treated patients. None of these three patients achieved complete aneurysm occlusion. Among all analyzed variables, such as aneurysm size, device type used, age, and appearance of the eclipse sign pre- and post-FD, the most reliable predictor of permanent aneurysm occlusion at 12 months was earlier, prolonged, and sustained eclipse sign visibility in more than three angiographic phases in comparison to the baseline (p < 0.001). Elevation in flow velocities within the ipsilateral vascular territory was noted in 70% (9/13), and bilaterally in 54% (7/13) of the treated patients. None of the patients had silent emboli.ConclusionsIntra-aneurysmal and parent vessel hemodynamic changes after FD can be reliably assessed by the cerebral angiography and transcranial doppler with important implications for the prediction of successful treatment.
Highlights
Successful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device
Patients were included in the study if (a) the Flow diversion (FD) procedure was completed successfully without adjunctive or prior coiling, (b) there was visible eclipse sign on post embolization angiography, (c) reliable follow-up diagnostic cerebral angiogram (DSA) data were available within 12 months after initial treatment
We demonstrated that contralateral Mean flow velocities (MFV) can be increased in patients with patent circle of Willis (COW), highlighting the FD effect on all involved vascular territories and potentially accounting for previously reported contralateral intraparenchymal hemorrhage (IPH) [22]
Summary
Successful treatment of intracranial aneurysms after flow diversion (FD) is dependent on the flow modulating effect of the device. Multiple studies utilizing various quantification methods, such as computation fluid dynamics (CFD) [1], optical flow maps [2], and angiographic parameters [3] have defined intra aneurysmal hemodynamic changes as the principal physiologic mechanism associated with treatment success after placement of FD stents. To this date, no specific qualitative angiographic parameters following FD have been established as a uniform predictor of successful aneurysm thrombosis. The appearance of eclipse sign was postulated to predict the progression to complete angiographic occlusion of the treated aneurysms This hypothesis has not been fully investigated
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